Dealing with Bureacrats and Academics

Ours is a “Mom & Pop” clinic. Husband and wife team, more patients than we could deal with, more debt that we could pay off and we have never taken a break longer than the Christmas to New Year week.

Despite all of this we try and do our “civic duty” – we attempt to get to those critical meetings, we try and get involved with pre-grad teaching and now we are even working towards having a Registrar. After all these people make the rules in our work life and we cannot complain about poor quality graduates from the sidelines without doing something about it – right ?

The frustration lies in dealing with people who work for a salary, often have their head in an Academic cloud, and have no concept of the real-life pressures on a small medical business where time is money and patients see it as a personal let-down if you cannot make time to see them.

Firstly those Academics – we would love to attend the wonderful GP educational events held at our local Tertiary Hospital. At 12h30 midday on a Wednesday 30km away from us. I cannot understand how any busy full time GP could take a few hours off at that time of the week to sit in on a lecture. My comments to this effect were acted on – they now allow us to log in and participate remotely.I just need to get rid of the patients and make sure I somehow still generate an income to pay the staff up front and for the technology to watch my learned friends discuss things while my patients clamour at the front desk for attention.

To their credit they do have some evening meetings – and we even get fed a very basic meal if we do get to attend – nothing fancy though as Society has decided that Doctors are extremely corruptible so there are very strict rules on not feeding us anything fancy. The problem again is that these meetings usually start around 6:30PM and are typically at least a 30min drive from the Surgery. A tad of a challenge given that I rarely manage to get away from the Surgery before 7 or 8PM. Weekend education sessions are rare as the Educators believe that we should be relaxing on weekends – a nice idea for those who have the luxury of free time on their hands.

We have also tried to participate in some of the various panels and meetings that are constantly being held – we felt we needed to attend otherwise the only attendees are Academics, Public Servants and doctors from the larger clinics and we would have no right to complain about the outcomes. To this end we have blocked off the clinical time to drive to and attend these meetings only to arrive there and be informed that the meetings had been cancelled. Their mates down the corridor were informed but the self-employed GP at the other end of town was not important enough to be contacted.

The concept of this not only frustrating us but also costing us a significant amount of money is just too hard too grasp for the Executive Assistants and other Public servants who arrange these things. Many of the salaried VMOs involved in these processes have also never had to worry about Fee for Service as their only income.

Do not even get me started on the issue of how they send out their notices – I am about to give up op fighting with them about all those Ccd e-mail addresses and I guess I should be thankful that I now have the personal e-mail addresses of most doctors in the ACT. Not sure if the feeling is mutual though.

Finally we get to the fun of trying to get a Registrar on board for 2015. It took us many years to get to the point where this is actually even starting to be a reality. Getting information from the relevant parties is very much like pulling teeth – drips and drabs and we are lucky if we get any written response.

We do however get those bursts where we would have an e-mail with a request for a huge amount of information and off course a very short deadline in which to return it. Currently we are waiting for a half-a-day accreditation visit – this will take all the doctors and the practice manager away from work and we were told we will be informed about what is required of us a week or so before the visit – until then we are left in the dark. At the moment all we have is a lump of e-mail attachments, in no specific order, that covers various College guidelines and criteria. This was obtained after numerous requests – interestingly though we were informed that it was expected that we would respond immediately and without delay if they wanted anything from us as they would stop dealing with us if we did not do this – caused flashbacks to my regular spot on the carpet in front of the Principal’s desk many decades ago .

This is off course only step one – once we have been deemed “good enough” we need to start the fiddly process of trying to incorporate a future Registrar into our clinic. The exact details depends on the level of training and whether the Registrar is full-time or part-time. This uncertainly is a huge stressor for all the reasons already mentioned. If we do get a junior person we would need to block off a minimum of three hours a week for dedicated teaching time – something which we are not allowed to do after hours or on weekends. This person becomes an employee of the Practice, may in fact slow down the actual clinical services and is likely to make my debts larger and my days even longer but hey, we are doing our bit for Society aren’t we ?

Tell that to our kids.

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One Response to Dealing with Bureacrats and Academics

  1. DrKP says:

    A very frustrating story Thinus. . There are only about 100 Gps in Australia with PhDs. The rest are non medical background people. I find this a frustrating topic “leadership” in general practice for as you say there seems a great divide between those who are advising GP and being able as a clinician to afford those voluntary positions. There are many good and hardworking Gps like yourself giving up time and income on the Racgp and AMA committees. However health care is big business and unless you have an influential voice GPs will not be heard. I sympathise with the level of bureaucracy in engaging a Registrar. I had given up applying at one practice and now just teach med students. Part of the issue is that anything that is not seeing a patient is not considered to be a part of a medical professionals remit. Yet it most surely is our role to advocate for a health system that benefits patients but equally importantly provides a sustainable workplace for GPs. The erosion of income is a major part of this not having enough time to lead our profession. So many people think they know better. What concerns me is that hardworking Drs like you and your partner eventually burnout in a system that is stacked against your best interests. I have been in clinical practice for 25 years had my own practice for 9 years, teach med students and for the last two years been chair of women in GP vic faculty. The latter is an unpaid position. I am now taking up a part time PHD through Monash (unpaid!). So maybe I am an academic ?? ( I don’t feel like one). My point is your issues are very real and it would be a pity if voices like yours are not heard by Racgp /AMA. I do hope that you continue to advocate for professional advocacy and independence but maybe there are some people working away in a heinous system in policy and development who are trying their hardest to maintain the dignity of GP. I’ve seen some of them and it’s an uphill battle. Academics do have their place however and yet need very badly to hear the voices of coal face clinicians like yourself.
    I think your frustrations are a result of an erosion in our status as “professionals”. It has happened to teachers; to pharmacists who survive on shop front selling now; and now it’s happening to GP.

    Leadership and advocacy are very badly needed at a time of great transition in our profession. IMHO a sustainable workplace sustaining dedicated quality general practitioners is essential. That’s a part of my thesis. My hope is get to finish it and get to be a voice at the table. Thanks for your post which articulates many of those issues. I just don’t know if anyone is listening.

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